Dr Anderson Lodge

Dr Anderson Lodge provides nursing and personal care to people with a range of support needs, including dementia, physical disabilities and sensory impairment. It accommodates up to 60 people and 32 people were using the service at the time of the inspection.

People’s experience of using this service and what we found

People were supported by staff to stay safe. Risks to people's safety had been assessed and actions taken to reduce any known or potential risks that could harm them. People received their medicines as prescribed. A small number of medicine records were incorrect, and the medicine audit had not identified this. We found no evidence that people had been harmed. The registered manager immediately investigated how this had happened and acted to prevent a reoccurrence of this. Systems to ensure people were protected from risk of abuse were effective. The registered manager and staff understood their individual and collective safeguarding responsibilities. Staffing levels were safe and recent recruitment had been successful.

People and relatives were happy with the care and told us the staff were “very kind,” “caring” and “compassionate.” Relatives said their loved ones had improved in various ways, weight gain, grooming, and demeanour, since living in the home. They said, “When I see [name] and observe the amount of care staff give, I have no concerns at all about their safety,” and “I am happy with their care. [Name] is safe, warm and eating again. No one could look after them any better.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements. We were assured the provider was adhering to infection control practices. Infection prevention and control measures were in place and staff understood how to prevent the spread of infection. Staff wore personal protective equipment as required by the current guidance.

The registered manager had effective governance systems in place to maintain and improve the quality and safety of the service. Due to a change to an electronic system of recording medicines, the medicine audit had not picked up a difference in the way staff were recording medicine that was refused. The registered manager took immediate action to rectify this. Analysis of accidents and incidents included all accidents that had happened and identified any patterns or trends to help mitigate risk and prevent reoccurrence. People were provided with a good quality service, which was regularly assessed and closely monitored. Any shortfalls identified were addressed without delay. The management teams oversight at the home had greatly improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 24 November 2020). The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dr Anderson Lodge provides nursing and personal care to people with a range of support needs, including dementia, physical disabilities and sensory impairment. It accommodates up to 60 people, and 29 were using the service at the time of the inspection.

People’s experience of using this service:

People gave us positive feedback about the home. Relatives told us they had seen a lot of improvements in the year since the last comprehensive inspection, with one saying, “I thought it was good to begin with anyway, but you can see how things have got better.” One person using the service said, “It all looks very nice here now.”

Staff showed imagination in relation to the provision of activities, acknowledging the impact of the COVID-19 related lockdowns. One said, “It has been difficult but everyone is working really hard. We have music sessions with musical instruments, film nights with popcorn and pizza which people really like. We’ve just got NetFlix and the movie nights are really popular.” In our observations we saw staff took time to engage with people and spend time chatting with them.

Staff treated people with dignity and respect in their interactions with people, speaking with people with a genuine warmth and affection. People told us they valued the staff, with one describing them as, “lovely.”

Meals were well presented, and mealtimes were a calm and pleasant experience. People told us they enjoyed the food. People’s needs in relation to nutrition and hydration had been assessed, and where required referrals to external healthcare providers had been made.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans were detailed and reflected people’s needs. They were regularly reviewed to ensure any changes to people’s needs were incorporated, and people and their relatives, where appropriate, were encouraged to be involved in these reviews.

Rating at last inspection:

The last comprehensive inspection of this service identified multiple breaches and the service was rated inadequate (published December 2019) We subsequently carried out a focussed inspection, looking at two domains (published September 2020) and found the breaches we looked at had been addressed. The rating remained inadequate as we did not look at all domains. At this inspection we found the provider had addressed the remaining breaches of regulation and was no longer in breach.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service in December 2019. Multiple breaches of legal requirements were found. The provider completed an action plan after that inspection to show what they would do and by when to improve the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of ‘is the service effective?’, ‘is the service caring?’ and ‘is the service responsive?’, which contain those requirements.

The ratings from a previous focussed inspection completed in July 2020, for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at the last two inspections.

You can read the report from our last focussed inspection, by selecting the ‘all reports’ link for Dr Anderson Lodge on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Dr Anderson Lodge provides nursing and personal care to people with a range of support needs, including dementia, physical disabilities and sensory impairment. It accommodates up to 60 people, and 32 were using the service at the time of the inspection.

People’s experience of using this service:

People gave us positive feedback about the home. One person’s relative described the service as “fabulous” and another said they could see improvements had been made since the last inspection in December 2019. Another person’s relative said they had always found the staff to be: “brilliant, caring and accommodating.”

People were supported by staff who were deployed in sufficient numbers to meet their needs. Staff were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns. A relative we spoke with confirmed they felt their relative was safe at the home.

The home environment had much improved since the last inspection, with some improvements still to be made. The registered manager assured us these improvements were ongoing, and acknowledged some delays had been caused by the pandemic and the resultant restrictions on who could enter the home safely.

Medicines were managed in a way that had improved since the home was last inspected, and audits ensured managers had a good oversight of this. We found some minor shortfalls in the medicines we looked at, but the deputy manager assured us these would be addressed immediately.

The registered manager told us they had worked hard over the preceding eight months to address the breaches and shortfalls identified at the last inspection. They produced a comprehensive action plan, although we noted it did not cover all the areas CQC had requested. We saw evidence of many improvements, although we noted some areas, including how the provider obtains people’s consent, or how it proceeds when people lack the capacity to consent, required considerable further improvement.

Rating at last inspection:

The last rating for this service was inadequate (published January 2020)

Why we inspected:

This was a planned focussed inspection based on the rating at the last inspection. As this was a focussed inspection, we reviewed the key questions of safe and well led only.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Dr Anderson Lodge is a residential nursing home. The home can accommodate and provide care to up to 60 people with varying needs such as older people, younger people, people with sensory impairments, physical disabilities and dementia. There were 41 people living at the home at the time of our inspection. The main building, called the lodge had 27 people, a separate building called the annexe provided care to 14 people living with dementia.

People’s experience of using this service and what we found

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs and showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

The systems to help identify where improvements were required had been ineffective. The systemic failings found at this inspection demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate; placing people at risk of potential and continued harm.

People were not effectively protected from abuse because some staff did not recognise their responsibilities to ensure people were safe. People told us they felt safe living at the service. However, practices were not safe. Changes to people's health needs were not routinely addressed in a timely way.

The level of activities and meaningful occupation did not meet the social needs and wellbeing of everyone living at the home, especially people living in the annexe.

People and relatives said staff were kind and caring. However, people's privacy and dignity were not always respected. People's medicines were not well managed to ensure people received medicines as prescribed.

People were not always supported by staff who were suitably trained, assessed and monitored to carry out their role safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 10/10/2018 and this is the first inspection. The last rating for this service was good (published 24 October 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dr Anderson Lodge on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified nine breaches in relation to person centred care, safe care and treatment, dignity and respect, consent, safeguarding, nutrition, premise and equipment, governance and staffing.

Following the inspection the registered manager submitted an action plan to CQC to inform us of the action they intended to take and placed a voluntary suspension on admissions to the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.